Oh, you’re an idiot. Sorry. Forget we spoke.
Whee. :rolleyes:
Listen Richard (aptly named, you are)…
On preview, what Really Not All That Bright said:
They don’t look immoral, amoral or pound foolish. They are recovering money that is rightfully theirs, every bit as much as if they’d paid for a shipment of widgets and the supplier failed to deliver.
They aren’t responsible for the injury. Somebody else is. They aren’t responsible for her medical care.
The alternative would be that they refuse to pay for her medical care entirely until a court finds them liable. Would that make them look warm and cuddly?
Sure, they could waive their right to recover the money since this family has suffered. Where do you draw the line, though?
I disagree. They aren’t immoral or amoral, but they certainly LOOK it to many average Americans who believe WalMart has bottomless pockets and can afford to let this woman and her family have their million. But they wouldn’t have had the million anyway, it was quickly being used for her care and her care is being extensively subsidized by the taxpayer. WalMart just helped that burden shift faster from the family (via the settlement) onto us.
What the FUCK?!?!?!?
We’re talking about a fucking health plan, here! If a goddamned health plan is not supposed to cover costs of medical care, WTF is it supposed to do? WTF does a Wal-Mart employee do if they get injured and they can’t sue someone? Pay it back out of their own pocket?
Look, you can argue the morality of recovering payments from settlements, and I may disagree, but I won’t think you’ve got your head up your ass.
But saying, in all seriousness, that a health plan isn’t responsible for medical care? WTF?
I don’t understand why people are talking about matters of scale on one side, but not the other. I seriously doubt that this woman will remain the only Wal-Mart employee to receive an insufficient settlement for medical damages. Yes, $470K won’t bankrupt Wal-Mart. But it’s not just this case that matters. Wal-Mart employs (and, presumably insures some fraction of) hundreds of thousands (millions?) of people. They offer a completely reasonable insurance provision, but everyone wants them to play favorites in this case. Since we’re only talking about one $470K charge, is the assumption that any future people in a similar situation should get screwed? How is that justice?
But, of course, the next time that someone gets injured, doesn’t get enough money from the responsible party, and wants to smear Wal-Mart, we can again argue that $x really isn’t that much, and ignore the fact that there’s a bigger picture.
I am not suggesting that a health plan isn’t generally responsible for medical care. I am saying that a health plan isn’t responsible for caring for someone injured by the negligence of a third party.
There are, simply put, times when your health insurer isn’t responsible for your medical bills. If you suffer a work-related injury, for example, your employer (or their insurer) is responsible for your care.
This may seem odd, or even wrong, but it’s how the law works. Moreover, it has to be this way, or here’s what would happen:
- Person X gets a piano dropped on them from a window
- Person X meets with an attorney who says piano delivery company is liable for his/her injuries
- Person X knows litigation takes a while and wants medical care, so gets treated under his/her health insurance
- Person X files lawsuit against piano people, uses medical billing records to drive up value of claim
- Jury awards Person X a big lump sum, plus reimbursement of medical costs
- Person X walks away with a sore head and twice as much money as he/she should have received.
In which case, this is what happens next time:
- Person X gets hit by piano, etc.
- Person X speaks to attorney
- Person X files health insurance claim
- HMO/PPO refuses Person X medical treatment, citing piano company as party correctly liable for medical care (Person X receives critical care anyway, but hospital not getting paid so refuses to provide non-critical care: physical therapy, rehabilitation, etc.). HMO/PPO does this because they know there’s no way they can get their money back if they pay for stuff now
- Person X files suit against piano company/piano company’s insurer to obtain care
- Person X has to wait aeons before piano guys authorize treatment because litigation takes forever
- Person X is left with long-term impairment due to lack of available medical care
This page provides a pretty good explanation of subrogation.
ETA: There are plenty of good reasons to hate Wal-Mart, but this isn’t one of them. They are doing, essentially, what they have to do. There is a responsible party here, but it isn’t them- it’s the trucking company, their insurer, or the plaintiffs’ attorney.
Sorry- missed the edit window.
“But what,” I hear you cry, “if the jury is simply instructed to provide for Wal-Mart to be reimbursed?”
Well, then we’re back to square one, because Wal-Mart has apparently paid out enough money to eat up most of the judgment against the trucking company anyway.
Even if this case had gone to trial, as noted by others above there probably isn’t any more money under the trucking company’s insurance policy; somebody is getting stiffed either way.
The truck company would be on the hook for the rest, but good luck actually getting any more money from them.
Also, a clarification: everyone is talking about this as if Ms. Shanks missed “the fine print” when enrolling in her health plan. This is not true; there is no fine print, there was no sneaky rider on the policy. Subrogation rights are granted by the law, not by the terms of the contract itself.
IANAHMO, but I think you’re misunderstanding how subrogation works, particularly step four of your second scenario. From the link you provided:
From personal experience, my wife’s car was once struck by a drunk driver. In addition to extensive damage to the car, she required some medical treatment. Our HMO paid her doctor’s bills in full without question at the time, and afterwards we had to fill out some papers and sign a release authorizing them to take any necessary action to recover their expenses from the other driver. Our auto insurance had us sign similar release so they could attempt to recover their expenses. As it turned out, the other driver was uninsured and disappeared after the accident so both insurance companies were out of luck. But at no point did they refuse to pay anything. The only thing we ever heard from them about it afterwards was a notice (IIRC from our auto insurer) that they had been unable to locate the other driver, and asking us if we had any information which might assist tthem in this.
I think, Really Not All That Bright, we’re arguing at cross-purposes here.
I see what you’re saying about subrogation, and the need for it. Nor do I really disagree.
The problem is that, compared to the example you suggest in post #87, in this case, even an (assumed) aggressive and timely treatment plan, with rehabilitation, has still left the patient in nursing home care for the rest of her life. Your, and Foxy40’s concern about double-dipping is completely credible, when dealing with a situation where one can say, this patient is now at status quo ante. At which point the medical costs for such an accident are finished. Having the insurance recovering their costs from a third party won’t be reducing the care that the patient has received, because it’s all done.
In this case, the care for the damage from the accident is still ongoing. And will be until this woman dies. Taking the settlement money is going to affect the care that the woman is getting, AIUI. Which is very different from the original situation you propose for consideration.
And of course, I have to admit, this is pretty clearly, one more instance to illustrate the expression that “Interesting cases make for bad law.” I can’t imagine any way to legislate a solution to this situation that wouldn’t cause problems in the future.
On preview: Lurkmeister, is it possible that you had uninsured motorist coverage, or collision, and your insurance company may have simply transferred the payout, in their accounting, from something they were subrogating, to another administrative category?
My scenarios were based on what would happen if subrogation rights didn’t exist- I was trying to demonstrate to OL why it “has” to be this way.
Your experience is a perfect example of how subrogation works (except that they didn’t get their money back, of course).
Wal mart also takes out life insurance on their employees. They profit from their deaths. They are definitely a business that has little care of potential bad press.
Once could argue that they are just covering their assets.
After all, my wife has a pretty hefty life insurance policy on me, and I don’t get a DIME of that when I’m dead.
Also, doesn’t a life insurance policy on my person involve me signing some paperwork, which I could refuse to do?
Yes, we did have uninsured motorist coverage. It’s possible that the auto insurance company might have done that without bothering to notify me.
And Really Not All That Bright, sorry that I misunderstood the point of your second scenario. As my experience relates to the WalMart case, however, it’s still relevant that any action to recover medical expenses would have been taken by my HMO, possibly on my behalf, not by me directly. If WalMart, in their position as her health insurance provider, wanted to recover their costs then they should have been a party to the lawsuit, and assumed part of the legal expenses, instead of merely sitting back and waiting for her case to be settled, then stepping up and saying, “Oh, didn’t you realize that we have first claim on any medical expense money you collect?” As I understand subrogation, it requires that the insurance company take action to recover their costs, not that they can just sit on the sidelines until somebody else takes action and then swoop in with their hands out.
Nope, I can take out life insurance on you without your knowledge - that is, if I knew your real name. Its fairly standard in business to take out business life insurance policies on critical employees - the idea is that you will experience a fairly major business impact if your critical employee dies. WalMart takes them out on the part time girl at the snack bar, hoping she will keel over. Actually, I don’t think they quite do that - I think they actually target their 50 year old overweight employees. They are functionally gambling that their employees will die and the payouts will exceed the premiums. Nothing illegal, but betting on people’s deaths isn’t exactly classy.
What kind of lawyer assumes an insurance company is going to just blow off half a million dollars? Probably the same kind that takes almost 60% of a settlement. This poor family wasn’t taken advantage of by Walmart’s insurance plan, but by their own legal team. I don’t expect a shelf stocker at Walmart to understand subrogation, but her lawyer should have.
The lawyer’s story sounds a bit off. Lawyers simply don’t assume an insurance company is going to write off half a million bucks. Either they fucked up and won’t admit it, or the husband simply gambled and didn’t think he’d get caught.
is this the pit? wha?
an update:
tonight (tuesday) on keith olbermann it was reported that walmart will keep the paperwork that claims them victorious, and allow the money left in the trust fund for ms. shank to stay in the fund for her care. her husband received a letter from walmart today explaining the decision.
for those interested… mr. shank will be on msnbc countdown with keith tomorrow (wednesday).
on the life insurance question… anyone can take out a policy on you without you knowing. depending on where you live, you only need to be informed above a certain money amount; then you have to sign that you have been so informed, and agree to the policy.
Umm, let us see now- Of the million ucks, Wal-mart is getting 40%, and they provided $400K+ of medical services to the woman. The Lawyer is getting 60%, and all he has done is file a few briefs and generally fuck his clients case up and run with the money. But it’s Wal-Mart who’s the eviiiiil one. :rolleyes: :rolleyes:
This is untrue for nearly all jurisdictions. See here.
Generally insurance companies (if not state law) require that you have insurable interest in whatever you’re insuring. For life insurance, that means a close familial tie (anything more distant than uncle/nephew is difficult to demonstrate unless you were, say, raised by a third cousin), or a demonstrable financial interest.
It can also mean a financial interest- as noted above, an employer can take out a policy against the lives of critical employees; also, partners or stockholders can insure against the death of company officers or other partners/stockholders, or a creditor can take out a policy on his debtor.
You can’t just go around looking for people to take out life insurance on, though. Otherwise, you could just find some old biddy, insure against her death, and spend a couple of weeks jumping out from behind bushes until she keeled over.
-RNATB, Licensed in Florida as a life, health and variable annuity agent.
Not necessarily. If the insured cannot easily demonstrate insurable interest, the insurer might require you to sign off and/or produce documentation establishing that the insured (not you, the person buying the policy) has an insurable interest.
If it’s your wife, though, she’s probably not required to inform you of the policy, depending on where you live (and very occasionally on the size of the policy).
ETA: Turns out my insurance license expired in January. Whoops.
Wal-Mart isn’t really a party to the suit, though it may be named as such. As subrogor, all they do is send letters to all parties saying something like:
“Wal-Mart hereby asserts its subrogation rights under [insert applicable statute] and requests that you acknowledge its right of lien pursuant to [statute]. Wal-Mart further objects to the distribution of funds resulting from any resolution or judgment in this matter without its prior knowledge and express written consent.”
In other words, their only responsibility is to let everyone know that they believe they have a right to claim a portion of whatever gets paid out on the lawsuit.
That said, I can almost guarantee that WM had some sort of counsel (general liability, I’d guess) representing them in regard to this lawsuit and reminding everyone of their subrogation rights constantly. The claim probably settled at a mediation, and Wal-Mart’s attorney would almost certainly have been present.
Even if they didn’t, the plaintiff’s attorney knew very well that they had a claim to a portion of the settlement. Wal-Mart has exactly zero interest in keeping the medical bills they paid a secret; in fact, refusing to produce a payout ledger (record of everything they paid on this particular claim, basically) a secret might be seen as a waiver of their lien.